THONG TIN Y DUOC
M A Y C H U P C A T L O P Q U A N G H O C ( O C T ) BAN PHAN TRl/OC NHAN CAU
(Biii Thi Van Anh*)
Thap nien 80 cua the h XX danh ddu budc ma ddu cho hang loat cdc tien bp vupt bac trong Nhan
khoa. Cdc img dung khoa hoc cdng nghe vao chdn doan vd dieu tri benh mdt da dem lai nhung thanh qua to Idn trong cdng cudc phdng chdng mu Ida a I let Xam cung nlur n-en the gidi. Cdc dang may hien dai. sir dung kv thudl tien tien. cd hieu qua dieu tri cao dd dirpc dira vdo ung dung tai cac ca sa nhdn khoa lain sdng. due biet tai cdc benh vien Trung uang vd thanh phd ldn. Cdc thiet bi giiip chdn doan benh sdm. chinh xdc cung dd duac chii trong. ddc biet Id cdc may de danh gid hinh anh. chuc ndng cua ban phdn trade nhdn can. Trong sd do. may chup cat Idp ban phdn trudc nhdn cdu giiip hoan thien chdn doan cdc benh nhdn khoa ndi chung va cdc benh ly ban phdn trudc ndi rieng da bdt ddu duac sudung rdng rdi a liet Xam.
TV /jTa% OCT ban phan trudc la dang ma\
1 VAchup cat lop sir dung tia hong ngoai co birdc song 1310 nm de phan tich cac lop to chirc nhan cau \6i dp phan giai o' mire 18 micron. VcVi budc song cao hon han. OCT ban phan tnrdc cho phep khao sat cae \iing to chirc dac biet ma cac dang ma\ OCT tnrdc da\ khdng the khao sat diroc nhu \ img chan mdng mat. gdc tien phdng eimg nlur cac \ img bi che lap boi seo giac mac. mang xuat tiet viem... Ngoai ra. dp phan giai cao cua OCT ban phan trudc cdn giiip cd the phan biet duoc nhirng tha\ ddi rat nhd eimg nlur do dac dupe cac thanh phan. khoang each eua ban phan trudc nhan can. Cac phan mem ciia max OCT ban phan trudc ed the dua ra cac thdng so chinh xac cua ban phan trudc nhu: dd da\ giac mac. dd sau tien phdng. do md gdc tien phdng... giiip loai bd rat dang ke cac sai sd do kha nang udc lupng cua tirng bac si. k\
thuat vien tnrdc day Hon nira. cae phan mem trp giiip cdn cho phep hien thi true tiep. luu giir ciing nlur chup lai cae hinh anh dir lieu trong qua trinh
kham xet. Chinh nhd dd. cdng tac hdi chan. theo ddi benh nhan va giang da\ dupe nang cao chat luong dang ke. Cac hinh anh hien thi va liru giu \di chat lupng cao. trung thuc cdn giiip cho benh nhan cd the true tiep quan sat dupe tinh trang mat ciia chinh minh. Do vay, benh nhan cd the hieu biet hon
\e tinh trang benh ciia minh \a ket hop tdt hon vdi bac sT trong qua trinh dieu tri.
Cac tinh nang uu \ iet tren cua ma\ chup OCT ban phan trudc da dupe cac bac si nhan khoa irng dung \ao qua trinh chan doan. dieu tri va theo ddi benh nhan trong rat nhieu ITnh \ uc:
BENH LY VA PHAU THUAT GIAC MAC Max OCT ban phan trudc hd trp cac bac sixac dinh \ i tri chinh \ac cua seo. di vat hoac cac tdn thuong benh K khac trong tirng Idp sau giac mac (d bieu md. nhu md ndng. nhu md sau ha\ o Idp ndi md). Tren co sd dd cac phau thuat vien cd the lira chpn dupe chi dinh phau thuat chinh xac nhu:
- Ghep ndi md giac mac.
*Khoa Gldcom - Benh vien Mat Trung inmg
50 Nhan khoa Viet Nam (So 17 4/2010)
- Ghep giac mac xuyen thung.
- Ghep giac mac IcVp.
Ngoai ra, sau phau thuat ghep giac mac, may OCT ban phan truac con giiip cac phau thuat vien danh gia tinh trang seo mo, tinh trang manh ghep giac mac cung nhu nen giac mac cti... Nhd dd cd the quyet djnh xii tri bien chimg hoac phau thuat bd sung sdm.
Hinh I. Seo sau ghep gidc mac PHAU THUAT KHUC XA
Vdi kha nang dua ra cac thdng sd do dac chi tiet, chinh xac ciing nhu danh gia toan dien tinh trang giac mac, dd sau tien phdng, dd cong mat trude the thuy tinh, may OCT ban phan trudc hd trg tich cue cae bac si trong:
- Chi djnh phuang phap phau thuat thich hop cho tirng benh nhan cd tat khiic xa nhu: phau thuat Lasik, phakic hay phau thuat phaco...
- Chi djnh phau thuat laser dieu trj tat khiic xa (can, loan & vien thj) phii hgp nhat cho benh nhan nham dat thj luc tdi uu sau md.
- Do dac chinh xac de tinh dugc cdng suat the thuy tinh nhan tao phii hop cho timg benh nhan trudc phau thuat Phakic hay dat vdng giac mac...
- Danh gia tinh trang seo, the thuy tinh nhan tao va cac td chuc lan can sau phau thuat khiic xa. Tir dd cd the dua ra quyet djnh xii tri kjp thdi, phii hop cho cac trudng hgp cd bien chung hoac tien trien dac biet.
Hinh 2. Vat gidc mac sau Lasik
250 urn
Hinh 3. Dich dudi vat gidc mac sau md Lasik BENH BAN PHAN TRUOC
- OCT ban phan trudc cd the giiip phat hien cac tnrong hgp chan thuong hoac benh ly kin dao o
\iing gdc tien phdng hoac viing khuat sau td chirc seo aiae mac, sau nuing xuat tiet viem...nhu: bona
mang Descemet, diit chan mdng mat, dj vat, u gdc tien phdng, chan thuang the thuy tinh...
- OCT ban phan trudc giiip danh gia tinh trang giai phau cua cac td chirc ban phan trudc sau phau thuat ban phan trudc, sau chan thuong.
Nhan khoa Viet Nam (So 17 4/2010) 51
Hinh 4. Ldp phim nirdc mat BENH GLOCOM
OCT ban phan truac la thiet bj giiip cho bac sT chan doan sam va dieu trj hieu qua hern doi vai benh glocom do co the:
- Chan doan phan biet dugc glocom goc dong hay goc ma giup bac sT quyet djnh dieu trj cho benh nhan bang thuoc hay phau thuat.
- Danh gia tinh trang bgng tham ket mac va viing be ciing - giac mac.
- Danh gia kha nang thoat luu thuy djch sau phau thuat dat van dan luu tien phong.
- Xac dinh cac dang glocom dac biet nhu glocom mong mat phang, glocom trong mot so hoi chung...
Hinh 5. Banh gid gdc tien phdng X-Y Image: 100 / 200
2534.4 um
Hinh 6. Ld cat mdng mdt chu bien
52 Nhan khoa Viet Nam (So 17 4/2010)
THONG TIN Y DUVC I
- Danh gia truoc phau thuat de dua ra cac thong so chinh xac tinh cong suat the thiiy tinh nhan tao.
- Danh gia tinh trang the thiiy tinh nhan tao sau khi dat co on dinh hay bi di lech, nghieng...
CHAN DOAN VA DANH GIA PHAU THUAT DUC THE THUY TINH
Nhu vay, kha nang irng dung ciia max. OCT ban phan truoc trong chan doan va dieu tri rat rong rai. Tuy nhien, viec sir dung hieu qua cac dang may moc hien dai doi biii kha nang hieu biet. ky nang su dung cua tirng bac si ciing nlur kha nang hop tac va hieu biet cua tirng ngudi benh.
TAI LIEU THAM KHAO
1. YOSHIAKI YASUNO 1, 4. MASAHIRO YAMANARI I. 4. KE1SUKE KAYVANA 2. 4. TETSURO OSHIKA 2, 4 AND MASAHIRO MIURA 3. 4. "Investigation of post-glaucoma-surgery structures hy three-dimensional and polarization sensitive anterior eve segment optical coherence tomography ".
OPTICS EXPRESS Vol. I 7. No. 5 /. 2 March 2009 .Optical Society of America. 2009.
2. STEINERT RF, HUANG D. "Anterior segment optical coherence tomography". Thorofare, NJ:
SLACK Incorporated: 2008.
Nhan khoa Viet Nam (So 17 4/2010) 53
